地西他滨联合预激方案初治高危骨髓增生异常综合征及老年急性髓系白血病的临床观察
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摘要
目的:探讨地西他滨(DAC)联合预激方案初次治疗高危骨髓增生异常综合征(MDS)及老年急性髓系白血病(AML)的疗效和不良反应。方法:回顾性分析首次接受DAC联合预激方案(DAC 25 mg qd,d_(1～5);Ara-C 10 mg/m~2q12h,d_(6～12); Acla 12 mg/m~2qd,d_(6～9); G-CSF 200μg/m~2qd,WBC> 20×10~9/L则停用)治疗26例高危MDS及老年AML患者的疗效和不良反应。结果:26例高危MDS及老年AML患者中,完全缓解率42. 3%,总体反应率(完全缓解+部分缓解) 65. 4%,中位生存时间为16. 2个月。结论:DAC联合预激方案治疗高危MDS及老年AML患者疗效确切,且安全性高,但由于本研究样本量较小,需进一步开展多中心随机对照试验证实。
Objective To explore the efficacy and side effects of decitabine( DAC) combined with CAG regimen for high-risk myelodysplastic syndrome( MDS) and elderly acute myeloid leukemia( AML). Methods: A retrospective analysis was performed on the efficiency and side effects of DAC combined with CAG regimen( DAC 25 mg qd,d_(1～5),Ara-C 10 mg/m~2 q12 h,d_(6～12),Acla 12 mg/m~2 qd,d_(6～9),G-CSF 200 μg/m~2 qd,WBC > 20 × 10~9/L then stop)for 26 cases of high-risk MDS and elderly AML. Results: Among the 26 cases of high-risk MDS and elderly AML,complete remission( CR) rate was 42. 3%. The clinical efficiency( CR + PR) was 65. 4%. None of the patients died early. Median survival time was 16. 2 months. Conclusion: The DAC combined with CAG regimen for high-risk MDS and elderly AML patients had definite therapeutic effect,and high safety. Due to the small sample cohort,multicenter randomized controlled trial is necessary.
Objective To explore the efficacy and side effects of decitabine( DAC) combined with CAG regimen for high-risk myelodysplastic syndrome( MDS) and elderly acute myeloid leukemia( AML). Methods: A retrospective analysis was performed on the efficiency and side effects of DAC combined with CAG regimen( DAC 25 mg qd,d_(1～5),Ara-C 10 mg/m~2 q12 h,d_(6～12),Acla 12 mg/m~2 qd,d_(6～9),G-CSF 200 μg/m~2 qd,WBC > 20 × 10~9/L then stop)for 26 cases of high-risk MDS and elderly AML. Results: Among the 26 cases of high-risk MDS and elderly AML,complete remission( CR) rate was 42. 3%. The clinical efficiency( CR + PR) was 65. 4%. None of the patients died early. Median survival time was 16. 2 months. Conclusion: The DAC combined with CAG regimen for high-risk MDS and elderly AML patients had definite therapeutic effect,and high safety. Due to the small sample cohort,multicenter randomized controlled trial is necessary.
引文
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[8]Cheson BD,Greenberg PL,Bennett JM,et al. Clinical application and proposal for modification of the International Working Group(IWG)response criteria in myelodysplasia[J]. Blood,2006,108(2):419-425.
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[12]Wang XM,Wang L. Clinical observation and safety analysis of the Decitabine treatment of elderly acute myeloid leukemia patients[J]. Chinese Journal for Clinicians,2017,45(10):62-64.[王秀梅,王淋.地西他滨治疗老年急性髓系白血病的疗效观察及安全性分析[J].中国临床医生杂志,2017,45(10):62-64.]
[13]Kantarjian HM,Thomas XG,Dmoszynska A,et al. Multicenter,randomized,open-label,phase III trial of decitabine versus patient choice,with physician advice,of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia[J]. J Clin Oncol,2012,30(21):2670-2677.
[14]Lubbert M,Ruter BH,Claus R,et al. A multicenter phase II trial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy[J].Haematologica,2012,97(3):393-401.
[15]Ai H,Wei XD,Yin QS,et al. The clinical safety and efficacy of low dose subcutaneous decitabine in treating acute myeloid leukemia and intermediate-or higer-risk myelodysplastic syndromes in the elderly patients[J]. Chinese Journal of Internal Medicine,2017,10(8):606-609.[艾昊,魏旭东,尹青松,等.低剂量地西他滨皮下注射治疗老年急性髓系白血病及中高危骨髓增生异常综合征安全性与疗效观察[J].中华内科杂志,2017,10(8):606-609.]
[16]Zhou HW,Zhou MH,Wang ZH,et al. Clinical efficacy of decitabine combined with or without cytarabine-based low dose regimen for senile patients with acute myeloid leukemia[J]. Journal of Experimental Hematology,2018,26(1):91-96.[周宏伟,周敏航,王志红,等.地西他滨单药或联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病的临床分析[J].中国实验血液学杂志,2018,26(01):91-96.]
[17]Yamada K,Furusawa S,Saito K,et al. Concurrent use of granulocyte colony-stimulating factor with low-dose cytosine arabinoside and aclarubicin for previously treated acute myelogenous leukemia:a pilot study[J]. Leukemia,1995,9(1):10-14.
[18]Yang XL,Wu YM,Cao YB,et al. Clinical efficacy of decitabine combined with CAG regimen for myelodysplastic syndromeRAEB and refractory acute myeloid leukemia[J]. Journal of Experimental Hematology,2015,23(4):1056-1061.
[2]Steensma DP,Baer MR,Slack JL,et al. Multicenter study of decitabine administered daily for 5 days every 4 weeks to adults with myelodysplastic syndromes:the alternative dosing for outpatient treatment(ADOPT)trial[J]. J Clin Oncol,2009,27(23):3842-3848.
[3]Wu D,Du X,Jin J,et al. Decitabine for treatment of myelodysplastic syndromes in chinese patients:An open-label,phase-3b study[J]. Adv Ther,2015,32(11):1140-1159.
[4]Gao S,Qiu H,Jin Z,et al. The clinical efficacy of the patients of acute myeloid leukemia and myelodysplastic syndromes treated with decitabine alone,combined with half or one couse of CAG regimen[J]. Chin J Hematology,2014,35(11):961-965.
[5]Sun Y,Xu Y,Wu D,et al. Outcomes of refractory or relapsed DNMT3A+cytogenetically normal acute myeloid leukemia patients followed the therapy including decitabine combined with CAG or CAG-like regimen[J]. Chin J Hematology,2015,36(12):1025-1030.
[6]Jin J. Chinese guidelines for the diagnosis and treatment of relapsed and refractory acute myelogenous leukemia[J]. Chin J Hematology,2011,32(12):887-888.
[7]Chinese Medical Association. Expert consensus on diagnosis and treatment of myelodysplastic syndrome(2014)[J]. Chin J Hematology,2014,35(11):1042-1048.
[8]Cheson BD,Greenberg PL,Bennett JM,et al. Clinical application and proposal for modification of the International Working Group(IWG)response criteria in myelodysplasia[J]. Blood,2006,108(2):419-425.
[9]Chinese Medical Association. Chinese guidelines for diagnosis and treatment of adult acute myeloid leukemia(not APL)(2017)[J].Chin J Hematology,2017,38(3):177-182.
[10]Kantarjian HM,O'Brien S,Huang X,et al. Survival advantage with decitabine versus intensive chemotherapy in patients with higher risk myelodysplastic syndrome:Comparison with historical experience[J]. Cancer,2007,109(6):1133-1137.
[11]Huang YQ,Zhang XY,Wu SX,et al. Curative effect of decitabine combined with IAG regimen for senile patients with myelodysplastic syndrome(MDS)transformed acute myeloid leukemia[J].Journal of Experimental Hematology,2017,25(6):1641-1646.[黄月琴,张学亚,吴诗馨,等.地西他滨联合IAG方案治疗老年MDS转化为急性髓系白血病患者的疗效观察[J].中国实验血液学杂志,2017,25(06):1641-1646.]
[12]Wang XM,Wang L. Clinical observation and safety analysis of the Decitabine treatment of elderly acute myeloid leukemia patients[J]. Chinese Journal for Clinicians,2017,45(10):62-64.[王秀梅,王淋.地西他滨治疗老年急性髓系白血病的疗效观察及安全性分析[J].中国临床医生杂志,2017,45(10):62-64.]
[13]Kantarjian HM,Thomas XG,Dmoszynska A,et al. Multicenter,randomized,open-label,phase III trial of decitabine versus patient choice,with physician advice,of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia[J]. J Clin Oncol,2012,30(21):2670-2677.
[14]Lubbert M,Ruter BH,Claus R,et al. A multicenter phase II trial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy[J].Haematologica,2012,97(3):393-401.
[15]Ai H,Wei XD,Yin QS,et al. The clinical safety and efficacy of low dose subcutaneous decitabine in treating acute myeloid leukemia and intermediate-or higer-risk myelodysplastic syndromes in the elderly patients[J]. Chinese Journal of Internal Medicine,2017,10(8):606-609.[艾昊,魏旭东,尹青松,等.低剂量地西他滨皮下注射治疗老年急性髓系白血病及中高危骨髓增生异常综合征安全性与疗效观察[J].中华内科杂志,2017,10(8):606-609.]
[16]Zhou HW,Zhou MH,Wang ZH,et al. Clinical efficacy of decitabine combined with or without cytarabine-based low dose regimen for senile patients with acute myeloid leukemia[J]. Journal of Experimental Hematology,2018,26(1):91-96.[周宏伟,周敏航,王志红,等.地西他滨单药或联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病的临床分析[J].中国实验血液学杂志,2018,26(01):91-96.]
[17]Yamada K,Furusawa S,Saito K,et al. Concurrent use of granulocyte colony-stimulating factor with low-dose cytosine arabinoside and aclarubicin for previously treated acute myelogenous leukemia:a pilot study[J]. Leukemia,1995,9(1):10-14.
[18]Yang XL,Wu YM,Cao YB,et al. Clinical efficacy of decitabine combined with CAG regimen for myelodysplastic syndromeRAEB and refractory acute myeloid leukemia[J]. Journal of Experimental Hematology,2015,23(4):1056-1061.